Provider Demographics
NPI:1831199694
Name:CAPUANO, MARIO JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:JOSEPH
Last Name:CAPUANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:260 MIDDLE COUNTRY RD
Mailing Address - Street 2:BUILDING 2, SUITE 12
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2568
Mailing Address - Country:US
Mailing Address - Phone:631-696-9752
Mailing Address - Fax:631-696-5096
Practice Address - Street 1:260 MIDDLE COUNTRY RD
Practice Address - Street 2:BLDG 2 SUITE 12
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2568
Practice Address - Country:US
Practice Address - Phone:631-696-9752
Practice Address - Fax:631-696-5096
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0459391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD20291Medicare PIN
NYU61869Medicare UPIN